Al-Mefty’s Meningiomas: Medicine & Health Science Books @ Al-Mefty’s Meningiomas Second Edition. Franco DeMonte, MD, FRCSC, FACS Professor of Neurosurgery and Head and Neck Surgery Mary. Al-Mefty O(1). Author information: (1)Department of Neurosurgery, University of Mississippi Medical Center, Jackson. Anterior clinoidal meningiomas are.
|Published (Last):||14 September 2012|
|PDF File Size:||8.11 Mb|
|ePub File Size:||16.63 Mb|
|Price:||Free* [*Free Regsitration Required]|
The optic chiasm and the optic nerves in both Group I and II tumors are wrapped in the arachnoid membrane of the chiasmatic cistern, and dissecting them free from the tumor is relatively easy with a microsurgical technique. Preoperative visual impairment improved in only two patients. Recurrence with eventual death occurred in five patients. In conclusion, this is a solid, up to date, and thorough review of the most common primary tumor of the central nervous system.
Group I If the meningioma’s origin is proximal to the end of the carotid cistern Group I meningikmas, as is the case with a meningioma originating from the inferior aspect of the anterior clinoid, the tumor will enwrap the carotid artery, directly adhering to the adventitia in the absence of an intervening arachnoid membrane Figs. The patient is placed supine and a spinal drainage needle is inserted. In seven of our cases, the optic nerve was totally engulfed, but in all cases the optic nerve maintained its arachnoid barrier formed by the wall of the chiasmatic cistern.
These chapters, while focused on surgery, are extremely well illustrated with anatomic drawings, MR and CT, and angiography. These tumors are usually small.
Although the tumor engulfs the vessels, this arachnoid membrane remains intact, making microsurgical dissection feasible despite total encasement of the vessels Figs. They described clinoidal or sphenocavernous meningiomas en masse as: When this membrane was absent Group I in our classificationdissection was impossible; none of the tumors was removed totally and the outcome was a disappointment.
This situation makes dissecting the tumor from the carotid artery and the middle cerebral artery branches impossible and explains why some authors describe tumors invading the arterial wall. These subgroups relate to the presence of interfacing arachnoid membranes between the tumor and cerebral vessels.
Lateral carotid megty demonstrating narrowing of the carotid and middle cerebral arteries by the encasing tumor. Despite total encasement of these vessels, a thickened arachnoid membrane separated the tumor from the mety in Group II tumors. Although meningiomas of the anterior clinoid invade the cavernous sinus, there exist meningiomas that are strictly intracavernous, originating from within the cavernous sinus.
Dissection continues on the proximal carotid artery and into the cavernous sinus.
It is a must-have in all neurosurgery, neurology, and radiology libraries. A 1-or 2-mm segment of naked internal carotid artery lies between the investment of the carotid cistern and the dura of the cavernous sinus.
Arterial Dissection Once the tumor is debulked, the distal branches of the middle cerebral artery are identified under high magnification and, using microdissection, the tumor capsule is removed from the arterial wall. Opening the dura under the microscope provides a transitional adjustment of the surgeon’s dexterity from bone work to fine microsurgical dissection.
The text begins with important information on anatomy, pathology, and epidemiology, followed by clinical and preoperative considerations. The book closes with incisive discussion of breakthroughs in radiosurgery, radiotherapy and chemotherapy. The arachnoid meftt not follow the internal carotid artery into the cavernous sinus space, nor is it attached to the anterior clinoid process.
Under the operating microscope, a plane of dissection is established between the tumor and the frontal and temporal lobes. I can opt out at any time by clicking the “unsubscribe” meningiomaz at the end of each newsletter. A striking difference in mortality and morbidity rates, failure of total removal, and recurrence is apparent whenever clinoidal meningiomas are compared with middle and lateral sphenoid tumors or with tuberculum sellae tumors.
To avoid injury to encased cerebral vessels, most surgeons are content with subtotal removal. They were in close contact with the internal carotid artery and its branches, which were shifted, stretched, or embedded, and with the optic nerve and tract. Total removal was achieved in 18 of the 19 patients in Group II, with one death from pulmonary embolism.
Foremost authorities present the milestone text on meningioma management, now in a fully updated Second Edition This is an excellent book and a needed update. The Role of Radiation Therapy The role of radiation therapy cannot be left unaddressed in a discussion of clinoidal meningiomas in which subtotal removal or recurrence are prominent features.
This book is organized into 11 sections with forty-four chapters. Computerized tomography CT scans in all cases revealed the presence of tumor and its extensions. This experience has distinguished three groups I, II, and III which influence surgical difficulties, the success of total removal, and outcome. The dura is then closed in a watertight fashion, the single bone flap positioned in place, and the skin closed in two layers.
Al-Mefty’s Meningiomas – Google Books
The role of radiation therapy cannot be left unaddressed in a discussion of clinoidal meningiomas in which subtotal removal or recurrence are prominent features. This maneuver intercepts the arterial feeders coming from branches of the middle meningeal artery. Dissection and tumor removal were facilitated by the presence of an intervening arachnoid membrane. When the tumor extends into the cavernous sinus, as it did in nine of our cases, proximal and distal control of the carotid artery is necessary.
Without total removal, however, recurrence is expected.